Application value of anterograde flexible ureteroscopy in the treatment of complicated kidney stones by PCNL
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摘要: 目的 探索顺行输尿管软镜在经皮肾镜取石术(PCNL)治疗复杂肾结石中的临床疗效及安全性。方法 回顾性分析2021年10月—2022年5月天津医科大学第二医院87例因肾多发结石及鹿角形结石行PCNL患者的临床资料。其中行单纯PCNL治疗46例(对照组)，行PCNL联合顺行输尿管软镜治疗41例(观察组)，比较2组结石清除率、手术时间、术后并发症、通道数目、二期手术率及术后住院时间。结果 87例手术均顺利完成，观察组与对照组术后3 d结石清除率[68.3%(28/41) vs 45.7%(21/46)，P < 0.05]和手术时间[(76.6±10.2) min vs (83.1±18.9) min，P < 0.05]比较差异有统计学意义。观察组术后发热发生率、Clavien-Dindo分级、二期手术率、术后住院时间与对照组比较差异无统计学意义。观察组多通道比例(9.8%)低于对照组(23.9%)，但差异无统计学意义。观察组较对照组术后3 d结石清除率高，手术时间短。结论 PCNL联合顺行输尿管软镜治疗鹿角形结石及多发肾结石具有一期清石率高、手术时间短的特点，并且不增加手术并发症发生率；有减少通道数目、降低二期手术率，缩短术后住院时间的潜力，值得推广应用。Abstract: Objective To explore the clinical efficacy and safety of anterograde flexible ureteroscopy in percutaneous nephrolithotomy (PCNL) in the treatment of complex kidney stones.Methods Eighty-seven patients who underwent PCNL for multiple renal stones and staghorn stones from October 2021 to May 2022 in our hospital were retrospectively analyzed. Among them, 46 cases were treated with PCNL alone (control group) and 41 cases were treated with PCNL combined with anterograde flexible ureteroscopy (observation group). Two groups were compared in terms of stone clearance rate, operation time, postoperative complications, number of channels, rate of second-stage operation and postoperative hospitalization time.Results All 87 surgeries were successfully completed, and the stone removal rate at 3 days after surgery (68.3% [28/41] vs 45.7% [21/46], P < 0.05) and the operation time ([76.6±10.2] min vs [83.1±18.9] min, P < 0.05) were compared between the observation group and the control group. The differences in the proportion of postoperative fever, Clavien-Dindo classification, proportion of second-stage surgery, and postoperative hospital stay were not statistically significant in the observation group compared with the control group. The proportion of multiple channel (9.8%) was lower than that of the control group (23.9%), but the difference was not statistically significant. The observation group had a higher stone clearance rate at 3 days postoperatively and shorter operative time than the control group.Conclusion PCNL combined with anterograde flexible ureteroscopy for staghorn stones and multiple renal stones has the characteristics of high first-stage stone clearance rate and short operation time, and does not increase the incidence of surgical complications. Also, it has the potential for reducing the number of channels, decreasing the rate of second-stage surgery, and shortening the postoperative hospitalization time, so it's worth promoting.
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表 1 2组患者的基线资料
例(%)，X±S 项目 对照组(46例) 观察组(41例) P值 性别 0.106 男 26(56.5) 30(73.2) 女 20(43.5) 11(26.8) 年龄/岁 55.4±12.8 53.0±12.5 0.397 BMI/(kg·m-2) 25.8±3.7 27.0±3.6 0.134 结石侧别 0.544 左 32(69.6) 26(63.4) 右 14(30.4) 15(36.6) 结石负荷/cm 4.7±2.6 4.0±1.5 0.117 结石累及盏数 0.560 1~3个 33(71.7) 26(63.4) 4~6个 11(23.9) 11(26.8) ≥7个 2(4.3) 4(9.8) 结石平均CT值/HU 923.5±215.3 939.0±289.7 0.776 
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表 2 2组患者手术指标比较
例(%)，X±S 指标 对照组
(46例)观察组
(41例)t值 P值 手术时间/min 83.1±18.9 76.6±10.2 2.043 0.045 术后3 d清石 21(45.7) 28(68.3) 4.517 0.034 通道数目 3.045 0.081 单通道 35(76.1) 37(90.2) 多通道 11(23.9) 4(9.8) Clavien分级 2.018 0.155 1级 42(91.3) 41(100.0) 2级 4(8.7) 0(0) 3级 0(0) 0(0) 4级 0(0) 0(0) 5级 0(0) 0(0) 二期手术 7(15.2) 6(14.6) 0.006 0.939 术后发热 4(8.7) 5(12.2) 0.033 0.855 术后住院时间/d 5.3±1.2 5.4±1.0 0.402 0.576
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